Individual
MARSHALL KIRK BASLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
5328 MAIN ST STE 122, LISLE, IL 60532-4185
(630) 324-8243
Mailing address
136 JOANNE LN, ROCHELLE, IL 61068-1301
(815) 713-5981
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004569
IL
Other
Enumeration date
02/22/2019
Last updated
02/22/2019
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